Challenges facing CSO’s in promoting access to universal health coverage in Siaya County: the experience of Ugunja Development Initiative
Introduction/Background.
In 2018, the county government of Siaya in partnership with Amref Health Africa Siaya Project launched a project to work with civil society organizations including U.D.I, to promote
enrolment of households in a planned universal health coverage program. At the inception of this partnership only about 27% of Siaya residents were on any form of insurance scheme. Our face
to face interviews with communities revealed that enrolment into health schemes was hampered by among others, poverty leading to inability to pay for premium, high dropout, poorly funded primary health care and inconsistent incomes among the majority who were largely employed in the informal sector.
Objectives.
1. reduce direct costs and out of pocket expenditures;
2. increase advocacy on registration and recruitment in insurance schemes; and to
3. improve access and coverage in public health facilities.
In addition to the 3 objectives, the County Government of Siaya planned to use the lessons learnt from this recruitment to help health planners to design an appropriate UHC program that would comprehensively address the needs of the vulnerable households.
Problem statement.
High income inequalities in Siaya County has created barriers to UHC, even when there is existing political stability. Siaya like other low and middle-income economies is actively pursuing policies to achieve UHC. There is the experience and evidence from different settings that could help to build the knowledge base in Siaya on the effective strategies used to introduce UHC in order to expand health service access, provide financial protection, improve health outcomes and enhance user satisfaction.
How, there seems to be limited committed leadership, low economic growth and a poor health system transformation that could improve governance, financing and healthcare services that are all critical for achieving UHC.
Methodology/ approach
In the recruitment of community members into universal health coverage, U.D.I used various mechanisms including exploiting opportunities presented by the CBO’s integrated health outreaches, targeting hard-to-reach areas, using chiefs barazas, holding road shows and making
door-to-door visits in collaboration with community health volunteers (CHV). U.D.I also carried out informal interviews to seek opinions of household heads on the UHC program.
Results/findings
From the analysis, Siaya presented with inadequate commitment towards promoting UHC including; minimal solidarity in health care financing; cases of dysfunctionality of health care system; minimal opportunities for continuous medical training; quality concerns in terms of drug stock-outs and other medical supplies, dilapidated health infrastructure and inadequate health workers due to incentives for locating in hard-to-reach places, general motivation, incentives, working conditions, access to higher institution of learning for purposes of CME for purposes of advancing in skills and career growth, dysfunctionality of human resource management at the devolved level with cases of low morale, disjointed promotions, salary differentials amongst workers in the same job group .
Implication.
Most counties have mature health systems with UHC but still need to adjust the national policies to county specific to meet changing circumstances.
Conclusions
From the analysis, most effective and sustainable action in the realization of county based UHC as guaranteed in the Constitution is through strengthening dialogue among CSOs, academia, and private sector, to maximize engagement towards implementation through Intersectoral and multi stakeholder approach.
Recommendation
Raise sufficient revenue to finance health systems and enact legislation to govern the program.
Establish health insurance subsidy program for the vulnerable, elderly and PWSD.
Strengthen accountability through developing and monitoring clear, explicit and measurable targets.
Develop differentiated strategies and address equity and remove barriers to access for the vulnerable.
KEY WORDS.
- NHC- National Health Coverage CSO- Civil Society Organization. CHV- Community Health Volunteers.
- PWSD- People Living with Severe Disability
- CBO- Community Based Organization.